Provider Demographics
NPI:1386171130
Name:MIAMI SPINE SPECIALISTS LLC
Entity type:Organization
Organization Name:MIAMI SPINE SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HYDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-532-0065
Mailing Address - Street 1:4308 ALTON RD
Mailing Address - Street 2:SUITE 830
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-4556
Mailing Address - Country:US
Mailing Address - Phone:305-532-0065
Mailing Address - Fax:305-532-9793
Practice Address - Street 1:4308 ALTON RD
Practice Address - Street 2:SUITE 830
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-4556
Practice Address - Country:US
Practice Address - Phone:305-532-0065
Practice Address - Fax:305-532-9793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207XS0117X, 2081P2900X
363A00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty